Basic Information
| Provider Information | |||||||||
| NPI: | 1568443919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JIMENEZ RIVERA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | URBANIZACION FLAMINGO HILLS CALLE | ||||||||
| Address2: | MAIN A 28 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877874706 | ||||||||
| FaxNumber: | 7877874706 | ||||||||
| Practice Location | |||||||||
| Address1: | CALLE 6 ESQUINA 13 BLOQUE H-1 OFICINA | ||||||||
| Address2: | # 3 SANTA MONICA | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877855454 | ||||||||
| FaxNumber: | 7877855454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 11173 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.